MRI More Accurate Than Fine-Needle Biopsy in Detection of Thyroid Cancer
诊断甲状腺癌症MRI比细针穿刺更准确
November 27, 2007 — Thyroid nodules are fairly common and are often benign, but some are cancerous. At present, the most important method to detect malignant nodules is fine-needle aspiration biopsy (FNA, but this technique can produce false-negative results, which can delay treatment and lead to local invasion. A new study suggests that dynamic contrast medium–enhanced magnetic resonance imaging (DCE-MRI) has higher accuracy and can detect papillary carcinoma that is missed by FNAB. The results are published in the November issue of the Archives of Surgery.
2007.11.27－甲状腺节结十分的常见，大部分的甲状腺节结是良性的，但是也有恶性的。目前，鉴别恶性节结最重要的手段是细针穿刺（FNA），然而这种方法仍有假阴性，这会导致治疗延误并致使局部转移。新的研究表明，有动态对比物作为介质的－增强磁共振（DCE-MRI)诊断甲状腺乳头状癌的优于细针穿刺，能发现一些细针穿刺遗漏的病例。这一结果发表在11月的《Archives of Surgery》一杂志中。
\"DCE-MRI is highly reliable in ruling out a diagnosis of carcinoma in multinodular thyroid gland,\" conclude the authors, led by Seldar Tezelman, MD, from Istanbul University in Turkey. The negative predictive value of DCE-MRI was 100% vs 58.3% for FNAB and 66.7% for frozen section (FS) analysis.
“DEC-MRI在诊断甲状腺多发节结的恶性肿瘤方面更具可靠性。”由Seldar Tezelman教授领导的土耳其伊斯坦堡大学的作者们，最后总结说。DEC-MRI具有100％的阴性排除率，FNBA中是58.3％，而冰冻切片（FS）是66.7％。
This is the most prominent finding, Dr. Tezelman commented to Medscape Oncology, and the 100% negative predictive value means that DCE-MRI can totally exclude the diagnosis of malignancy.
这是个突破性的发现，而且DEC-MRI100％评估阴性的病例基本上可以排除恶性肿瘤的诊断\"Tezelman教授在写给《Medscape Oncology》的评论中说道。
However, at this moment FNAB is the gold standard for diagnosis of malignancy in thyroid nodules, and DCE-MRI seems to be a helpful adjunct method in both diagnosis or exclusion, Dr. Tezelman added. It is too early to recommend DCE-MRI to be used instead because \"we need more patients to verify its superiority to FNAB, especially in multinodular goitre.\"
“尽管如此，细针穿刺依然是诊断甲状腺恶性节结的“金标准”，而DEC-MRI是一种诊断或是排除的有效的辅助手段。”Tezelman教授补充说，\"目前说DEC-MRI可以替代细针穿刺还为时过早，我们需要更多的患者来证实DEC-MRI优于细针穿刺，尤其是在多发性甲状腺节结的患者中。”
The researchers compared the 3 techniques in a group of 30 consecutive patients with nodular goiter. Final histopathologic examination revealed thyroid carcinoma in 11 (36.7%) patients, follicular adenoma in 2 (6.7%) patients, and colloidal nodular goiter in 17 (56.7%) patients.
研究者们用比较了3种技术在30位有甲状腺节结的患者中的应用。细针穿刺病理检查发现其中11位有甲状腺恶性肿瘤（36.7％），2人有滤泡性腺瘤（6.7％），17人是胶体状的甲状腺（56.7）。
DCE-MRI was carried out in all 30 patients and detected all 11 cases of thyroid carcinoma. All of the patients with thyroid cancer had delayed washout contrast enhancement, the researchers report, so sensitivity was 100%. However, 3 other patients also had a delayed washout pattern on DEC-MRI; of these, 2 patients had colloidal nodular goiter and 1 had follicular adenoma. Hence, the conditional probability of thyroid cancer in a patient with multinodular goiter with a delayed washout pattern was 0.78 (11/14 patients). This positive predictive value of 78.5% leads the researchers to estimate that if 5 patients with multinodular goiter exhibited the delayed washout pattern on DCE-MRI, 4 will probably have malignant lesions in the thyroid gland.
DEC-MRI也检查了所有30位患者，并发现其中的11人是甲状腺恶性肿瘤。研究者们声称，所有的甲状腺癌的患者都具有造影增强的延后消退，准确率达到100％。其他还有3位患者具有（DEC-MRI）磁共振影像的造影增强的延后消退，而在这三位患者中，最后发现2位是甲状腺乳头状癌，1位是滤泡性腺瘤。甲状腺癌在多发性甲状腺节结具有造影增强的延后消退的影像的的条件概率是0.78（14人中有11人表现）。通过78.5％的阳性率使研究者们声称，如果5位多发甲状腺节结具有造影增强的延后消退的影像，那么其中的4位在甲状腺中有恶性的病理变化。
This method yielded no false-negative results; therefore, the results of DCE-MRI in nodal goiter can be summarized as \"no delayed washout, no thyroid cancer,\" the researchers conclude.
这个方法没有发现假阴性的结果，研究者们说“DEC-MRI对于节结性甲状腺的诊断可以概括为”没有延后消退，就没有甲状腺癌。”
These results contrast with those obtained for FNAB. This technique was carried out in 17 patients with single dominant cold nodules, of whom 10 were found to have thyroid cancer on histopathologic examination. However, FNAB detected thyroid cancer in only 2 (11.8%) patients and found follicular neoplasia in 3 patients, but showed benign findings in 12 patients. In fact, 5 (41.7%) of these 12 patients with benign results on FNAB had thyroid carcinoma, so these were false-negative results. Hence, the negative predictive value of this method was 58.3%, the researchers report, although the positive predictive value was 100%.
这些结果和细针穿刺的结果相对比。细针穿刺在其中的17位发现为孤立性冷节结的患者中实施，最后病理结果发现，其中的10位是甲状腺癌。而，细针穿刺发现的甲状腺癌仅有2位（11.8％），发现3位为滤泡性腺瘤，而其他12位均显示为良性结果。事实上，在细针穿刺发现的12位良性肿瘤的患者中有5位（41.7％）最后证实是甲状腺癌，这个就是假阴性的结果。这个方法的假阴性率达到58.3％，尽管阳性的诊断结果的准确率是100％的，研究者们报道说。
In addition, FS analysis was performed in the same 17 patients with single dominant cold nodules, of whom 10 had thyroid cancer, and showed benign findings in 9 patients, thyroid cancer in 6 patients, and follicular neoplasia in 2 patients. The positive predictive value was 87.5%, and the negative predictive value was 66.7%.
另外，其中的17位孤立性的冷节结患者进行了冰冻切片（FS)的诊断，其中10位是甲状腺癌，但是显示的结果中，9人是良性的，6人是甲状腺癌，2位是滤泡性腺瘤。阳性的诊断率是87.5％，而阴性率为66.7％。
Table. Comparison of Diagnostic Methods in the Detection of Thyroid Carcinoma*
Outcome Measures DCE-MRI FNAB FS Analysis
Positive predictive value (%) 78.5 100 87.5
Negative predictive value (%) 100 58.3 66.7
Sensitivity (%) 100 50 70
Specificity (%) 84.2 100 85.7
Diagnostic accuracy (%) 90 70.6 76.5
表：比较诊断甲状腺肿瘤的方法（DEC-MRI，FBAN,FS）的结果：
阳性诊断率：78.5％，100％，87.5％
敏感率：100％，50％，70％
特性率：84.2％，100％，85.7％
诊断的准确性：90％，70.6％，76.5％
*DCE-MRI indicates dynamic contrast medium–enhanced magnetic resonance imaging; FNAB, fine
-needle aspiration biopsy; FS, frozen section.
DEC-MRI指的是增强MRI；FNAB是指细针穿刺活捡；FS是指冰冻切片。
Dr. Tezelman and colleagues conclude that the accuracy of DCE-MRI in the detection of thyroid carcinoma in patients with multinodular goiter was higher than that of both FNAB and FS analysis. Also, with its negative predictive value of 100%, this technique was more reliable than FNAB and FS analysis in ruling out a diagnosis of thyroid carcinoma, they add. As far as they are aware, this is the first prospective study to compare the diagnostic value of all 3 methods in the detection of thyroid carcinoma in multinodular goiter. The same group has another study in 26 patients that will be published in the December issue of Surgery.
Tezelman教授和他的同事们得出这样的结论，DEC-MRI在发现多发性甲状腺节结中的甲状腺恶性肿瘤比细针穿刺（FNAB）和冰冻切片(FS)。由于它预测阴性结果的准确率达100％，所以在筛查甲状腺恶性肿瘤的应用上，DEC-MRI比细针穿刺（FNAB）和冰冻切片(FS)更可靠。尽管如此，他们也提醒说，这只是比较这3中方法在诊断甲状腺多发节结中的甲状腺恶性肿瘤的首个前瞻性研究。同样的对其他26例患者的研究结果将在12月的《Archives of Surgery》杂志发布。 |
发表于 2007-11-30 01:23:03
